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Shiga-toxin (stx)-producing Escherichia coil (STEC), also referred to as Verocytotoxin (VT)-producing E. coil (VTEC) (25) are causes of a major zoonotic food-borne illness (12, 20) whose spectrum includes non-specific diarrhea, hemorrhagic colitis (42), and the hemolytic uremic syndrome (HUS) (21, 24) which is the leading cause of acute renal failure in children. Not only do VTEC rival non-typhoidal Salmonella spp. and Campylobacter spp. as the commonest agents of sporadic bacterial diarrhea (12, 37), they have also been responsible for massive outbreaks of illness with significant morbidity and mortality. Examples include the lunch-foodassociated Japanese outbreak in Sakai in 1996 (9) which affected over 6,000 children with 102 cases of HUS and 3 deaths and the food-borne outbreak in the U.S. in 1993 (8) which affected 500 cases with 171 hospitalizations, 43 HUS cases, and 4 deaths. HUS, the most serious complication of VTEC infection, is associated with significant long-term morbidity, with renal dysfunction in up to 40% of the patients, and a mortality rate of 3%-5% (27, 50). The syndrome occurs most frequently in young children with an annual incidence, in North America, of about 2-3 cases per 100,000 children under 5 years of age (12) in contrast to a roughly 10-fold higher incidence in this age group in Argentina (29). Given that no specific treatment is currently available for HUS, immunization against VTEC infection may be the only practical option for limiting the serious morbidity and mortality associated with this condition. Unfortunately knowledge about the nature of protective immunity associated with VTEC infection is still in its infancy.

The Nature of Immunity to the Escherichia coli Shiga Toxins (Verocytotoxins) and Options for Toxoid Immunization